A European perspective on auditory processing disorder – current knowledge and future research focus

This consensus statement on auditory processing disorder (APD) by experts on APD from 17 European countries was led by Professors Vivian Iliadou (Greece) and Doris Eva-Bamiou (UK).

Iliadou, V. V., Ptok, M., Grech, H., Pedersen, E. R., Brechmann, A., Deggouj, N., … & Veuillet, E. (2017). A European perspective on auditory processing disorder-current knowledge and future research focus. Frontiers in neurology, 8, 622.

Current notions of “hearing impairment,” as reflected in clinical audiological practice, do not acknowledge the needs of individuals who have normal hearing pure tone sensitivity but who experience auditory processing difficulties in everyday life that are indexed by reduced performance in other more sophisticated audiometric tests such as speech audiometry in noise or complex non-speech sound perception. This disorder, defined as “Auditory Processing Disorder” (APD) or “Central Auditory Processing Disorder” is classified in the current tenth version of the International Classification of diseases as H93.25 and in the forthcoming beta eleventh version. APDs may have detrimental effects on the affected individual, with low esteem, anxiety, and depression, and symptoms may remain into adulthood. These disorders may interfere with learning per se and with communication, social, emotional, and academic-work aspects of life. The objective of the present paper is to define a baseline European APD consensus formulated by experienced clinicians and researchers in this specific field of human auditory science. A secondary aim is to identify issues that future research needs to address in order to further clarify the nature of APD and thus assist in optimum diagnosis and evidence-based management. This European consensus presents the main symptoms, conditions, and specific medical history elements that should lead to auditory processing evaluation. Consensus on definition of the disorder, optimum diagnostic pathway, and appropriate management are highlighted alongside a perspective on future research focus.

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Remote microphone hearing aid systems drive beneficial neuroplastic change in the auditory systems of children with dyslexia and associated auditory processing weaknesses

This study provides strong evidence of beneficial neuroplastic change, measured through improvements in the electrophysiological responses of the brain to speech sounds, in children with auditory processing deficits, as a result of use of mild amplification with remote microphone hearing aid systems.

Hornickel, J., Zecker, S. G., Bradlow, A. R., & Kraus, N. (2012). Assistive listening devices drive neuroplasticity in children with dyslexia. Proceedings of the National Academy of Sciences, 109(41), 16731-16736.


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“Hidden hearing loss” is more likely due to APD than cochlear synaptopathy

Hearing loss due to abnormality of neural connections between the inner ear (cochlea) and, or in, the auditory nerve has been dubbed “hidden hearing loss” and is the subject of considerable recent research. Like APD, it is not detected by basic hearing tests. However APD is a far more prevalent condition than cochlear synaptopathy.

Musiek, F. E., Chermak, G. D., Bamiou, D. E., & Shinn, J. (2018). CAPD: The Most Common ‘Hidden Hearing Loss’ Central auditory processing disorder—and not cochlear synaptopathy—is the most likely source of difficulty understanding speech in noise (despite normal audiograms). The ASHA Leader, 23(3), 6-9.

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Terminology for Auditory Processing Deficits and Difficulties

Disability terminology: Are we listening?

This opinion article published by Hearing Health Matters contributes to current discussion on terminology to describe various types and degrees of auditory processing disorder. It points out that one of the terms being strongly promoted may not be acceptable to people with a hearing disability who, under our CRPD (Convention on the Rights of Persons with Disabilities) obligations should be involved in the discussion.

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Impairment of speaking rate perception in children with dyslexia

This study identifies a new type of temporal perception deficit in children with dyslexia; speaking rate perception.

There is considerable evidence suggesting auditory processing deficits may be a major contributor to dyslexia. Impaired perception of subtle components of speech sounds (phonemes) impairs phonological awareness which is thought to be a key underlying cause of dyslexia. Various temporal (timing) perception deficits in particular have been shown to be associated with dyslexia. These deficits are also common in children with APD. This study identifies a new type of temporal perception deficit in children with dyslexia; speaking rate perception. Appreciating speaking rate assists us to categorise the relative length of sounds. Some speech sounds, usually vowels, will be longer in a slow speaker than a fast speaker. Our brain normally allows for this in determining whether a speech sound is relatively short or long. This study shows that children with dyslexia are less able to compensate for speaking rate when trying to understand spoken speech. The authors conclude:

“Individuals with developmental dyslexia (DD) are impaired not only in tasks involving direct temporal processing, as shown in previous studies but also in the use of temporal information of a context that impacts the perception of subsequent target words. This inability to fully utilize rate normalization processes may influence the formation of abstract phonological representations in individuals with DD.”

Gabay, Y., Najjar, I. J., & Reinisch, E. (2019). Another Temporal Processing Deficit in Individuals With Developmental Dyslexia: The Case of Normalization for Speaking Rate. Journal of Speech, Language, and Hearing Research, 62(7), 2171-2184.


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Auditory Training Effects on the Listening Skills of Children with Auditory Processing Disorder

Broad speech-based auditory training leads to improvement in functional hearing in children with APD.

Loo, J. H. Y., Rosen, S., & Bamiou, D. E. (2016). Auditory training effects on the listening skills of children with auditory processing disorder. Ear and hearing, 37(1), 38-47.

The authors examined, in a group of children with APD, whether a 12-week computer-based auditory training program with speech material improved the perception of speech-in-noise test performance, and functional listening skills as assessed by parental and teacher listening and communication questionnaires. … Broad speech-based auditory training led to improved auditory processing skills as reflected in speech-in-noise test performance and in better functional listening in real life. The observed correlation between improved functional listening with improved speech-in-noise perception in the trained group suggests that improved listening was a direct generalization of the auditory training.


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Are Specific Language Impairment and APD distinguishable?

Specific language impairment (SLI) and APD appear intertwined, with the suggestion that differential diagnosis may be influenced by whether a child is assessed by an audiologist or speech-language therapist. Multi-disciplinary assessment (as occurs at SoundSkills) is advisable.

Ferguson, M. A., Hall, R. L., Riley, A., & Moore, D. R. (2011). Communication, listening, cognitive and speech perception skills in children with auditory processing disorder (APD) or specific language impairment (SLI). Journal of Speech, Language, and Hearing Research.


Miller, C. A., & Wagstaff, D. A. (2011). Behavioral profiles associated with auditory processing disorder and specific language impairment. Journal of communication disorders, 44(6), 745-763.


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Evidence of differences in electrophysiological recordings from the brain to sound in children with APD

Electrophysiological recordings of responses to sound in children with APD show differences at brainstem and cortical levels of the brain.

Mattsson, T. S., Lind, O., Follestad, T., Grøndahl, K., Wilson, W., Nicholas, J., … & Andersson, S. (2019). Electrophysiological characteristics in children with listening difficulties, with or without auditory processing disorder. International journal of audiology, 58(11), 704-716.


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Reducing Listening-Related Stress in School-Aged Children with Autism Spectrum Disorder

The use of remote microphone hearing aid systems reduced listening stress as measured by salivary cortisol and provided a range of benefits for children with ASD.

Rance, G., Chisari, D., Saunders, K., & Rault, J. L. (2017). Reducing listening-related stress in school-aged children with autism spectrum disorder. Journal of autism and developmental disorders, 47(7), 2010-2022.


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Remote microphone hearing aid systems assist hearing in some adult stroke patients

10-week use of remote microphone hearing aid systems by adult patients with stroke may lead to benefits in unaided speech in noise perception. The findings may indicate auditory plasticity type changes and require further investigation.

Koohi, N., Vickers, D., Warren, J., Werring, D., & Bamiou, D. E. (2017). Long-term use benefits of personal frequency-modulated systems for speech in noise perception in patients with stroke with auditory processing deficits: a non-randomised controlled trial study. BMJ open, 7(4), e013003.


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